Provider First Line Business Practice Location Address:
1291 S 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-980-6844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2025